title: Mental health and HIV sexual risk behavior among patrons of alcohol serving venues in Cape Town, South Africa.
abstract: BACKGROUND
  Alcohol-serving venues in South Africa provide a location for HIV prevention interventions due to risk factors of patrons in these establishments. Understanding the association between mental health and risk behaviors in these settings may inform interventions that address alcohol use and HIV prevention.
  
  
  METHODS
  Participants (n = 738) were surveyed in 6 alcohol-serving venues in Cape Town to assess post-traumatic stress disorder (PTSD) and depression symptoms, traumatic experiences, sexual behavior, and substance use. Logistic regression models examined whether traumatic experiences predicted PTSD and depression. Generalized linear models examined whether substance use, PTSD, and depressive symptoms predicted unprotected sexual intercourse. Men and women were analyzed separately.
  
  
  RESULTS
  Participants exhibited high rates of traumatic experiences, PTSD, depression, alcohol consumption, and HIV risk behaviors. For men, PTSD was associated with being hit by a sex partner, physical child abuse, sexual child abuse and HIV diagnosis; depression was associated with being hit by a sex partner, forced sex and physical child abuse. For women, both PTSD and depression were associated with being hit by a sex partner, forced sex, and physical child abuse. Unprotected sexual intercourse was associated with age, frequency and quantity of alcohol use, drug use, and PTSD for men and frequency and quantity of alcohol use, depression, and PTSD for women.
  
  
  CONCLUSIONS
  Mental health in this setting was poor and was associated with sexual risk behavior. Treating mental health and substance-use problems may aid in reducing HIV infection. Sexual assault prevention and treatment after sexual assault may strengthen HIV prevention efforts.
authors.affiliation: Department of Psychology and Neuroscience, Duke University, Durham, NC, USA. kathleen.sikkema@duke.edu
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.forename: Christina S
authors.initials: CS
authors.lastname: Meade
authors.forename: Krista W
authors.initials: KW
authors.lastname: Ranby
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.forename: Donald
authors.initials: D
authors.lastname: Skinner
authors.forename: Desiree
authors.initials: D
authors.lastname: Pieterse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D003863:Depression / Q000150:complications / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012309:Risk-Taking; D012725:Sexual Behavior; D013019:South Africa / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology; D019966:Substance-Related Disorders; D055815:Young Adult